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WORLD GASTROENTEROLOGY NEWS World Digestive Health Day 2013: LIVER CANCER Act Today. Save Your Life Tomorrow. Editorial

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WORLD GASTROENTEROLOGY NEWS World Digestive Health Day 2013: LIVER CANCER Act Today. Save Your Life Tomorrow. Editorial Editorial WORLD GASTROENTEROLOGY NEWS Official e-newsletter of the World Gastroenterology Organisation www.worldgastroenterology.org VOL. 18, ISSUE 1 APRIL 2013 World Digestive Health Day 2013: In this issue LIVER CANCER Act Today. Save Your Life Tomorrow. Awareness. Prevention. Detection. Treatment. Douglas R. LaBrecque, MD, FACP The Future of Colorectal Cancer Professor, Internal Medicine Prevention in Developing Countries University of Iowa Healthcare René Lambert, MD Chairman, WDHD 2013 Steering Committee The World Gastroenterology Organisa- Why liver cancer? Hepatocellular car- tion (WGO) established World Digestive cinoma (HCC, also known as primary Health Day (WDHD) in 2004. Although liver cancer) is variably estimated to be still celebrated on May 29th each year, the fifth to seventh most common cancer The Future of Colorectal Cancer 1,2 Prevention in the United States; the date on which WGO was incorpo- in the world and it continues to be the rated in 1958, WDHD has become a third most common cause of death from A perspective from a high burden, 1,2 sufficient resource country year long, global, public health, advocacy cancer (second most common in men) . Dennis J. Ahnen, MD and awareness campaign. WDHD an- In some countries, it is either the number nually focuses on a specific digestive or one (Mongolia) or number two malignant liver disorder with the goal of increasing neoplasm (China). In the United States awareness by the public, medical practi- of America, it is the fastest rising cancer tioners, government health policy makers, by incidence and death rate3. Every 30 and philanthropic groups of the need for seconds, one person in the world dies prevention, diagnosis and management from liver cancer, which is almost entirely of a specific global health problem. The preventable. The annual global death rate theme in 2013 is: LIVER CANCER: Act from HCC of just under 700,000 ap- Gallstone Disease – a Heavier Burden in Today. Save Your Life Tomorrow. Aware- proximates the annual incidence, reflect- India! ness. Prevention. Detection. Treatment. ing the limited therapeutic options as well Vinay K. Kapoor, FRCS, FACS, FACG as the late diagnosis in most cases4,5. Significant advances in diagnosis and therapy now produce a 50-70% five year survival in those diagnosed with early, minimal disease who receive the best current therapies. But such therapies are almost exclusively available in high resource countries, and even there not to all of the affected patients. Low resource countries tend to lack the broad public 2 WORLD GASTROENTEROLOGY NEWS APRIL 2013 Contents Editorial WDHD News World Digestive Health Day 2013: LIVER CANCER World Digestive Health Day 2013 19 Act Today. Save Your Life Tomorrow. 1 Douglas R. LaBrecque, MD, FACP WGO & WGOF News Scientific News 5th Egyptian Hepatology and Gastroenterology Post Graduate Course; 14th Egyptian International An Introduction to Two Perspectives on Colorectal Workshop on Therapeutic Endoscopy 21 Cancer Prevention 6 Ibrahim Mostafa, MD Henry J. Binder, MD Greger Lindberg, MD WGO Membership Update 23 The Future of Colorectal Cancer Prevention in Developing Countries 7 WGO Training Centers in Africa René Lambert, MD – A New Partnership in Training 25 The Future of Colorectal Cancer Prevention in the WGO Global Guidelines United States 12 Dennis J. Ahnen, MD WGO’s New Graded Evidence System 27 Justus Krabshuis Letter to the Editors Anton Le Mair, MD Gallstone Disease – a Heavier Burden in India! 15 Calendar of Events Vinay K. Kapoor, FRCS, FACS, FACG WGO Calendar of Events 30 World Congress GASTRO 2013 APDW/WCOG Shanghai News 16 VOL. 18, ISSUE 1 e-WGN Editorial Board Editor: Henry J. Binder, Greger Lindberg • Todd Baron, USA • Klaus Mergener, USA Managing editor: Leah Kopp • Jason Conway, USA • Douglas Rex, USA Art Production: Jennifer Gubbin • Rodolfo Corti, Argentina • Max Schmulson, Mexico Editorial Office:WGO Executive Secretariat, 555 East Wells • Paul Goldberg, South Africa • Nicholas Shaheen, USA Street, Suite 1100, Milwaukee, WI 53202 USA • Abdel-Meguid Kassem, Egypt • Parul Shukla, India Email: [email protected] • Rene Lambert, France • Martin Smith, South Africa • Joseph Lau, China, Hong Kong • Wendy Spearman, South Africa • Pier-Alberto Testoni, Italy • Nicholas Talley, Australia • Bader Fayaz Zuberi, Pakistan • Mamoru Watanabe, Japan • Chun-Yen Lin, Taiwan ©2013 World Gastroenterology Organisation. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form without the prior permission of the copyright owner. 3 WORLD GASTROENTEROLOGY NEWS APRIL 2013 Editorial | Scientific News | Letter to the Editor | World Congress | WDHD News | WGO & WGOF News | WGO Global Guidelines | Calendar of Events awareness and medical infrastructure, HEPATITIS B as well as generally available state of Hepatitis B is one of the most ne- the art technology (ultrasound, CT, glected epidemics in the world. One MRI) for early diagnosis. The current in 3 people worldwide have been best surgical and medical therapies are infected with HBV and 400,000,000 of very limited availability, if avail- have chronic hepatitis B. It is sec- able at all, due to high costs, lack of ond only to tobacco in causing the adequately trained medical personnel, most cancer deaths worldwide. The and limited to no coverage by govern- hepatitis B vaccine, the FIRST true ment health plans. anti-cancer vaccine, has been avail- Unfortunately, low resource coun- able since 1982 and is more than tries are disproportionately affected 95% effective. Global efforts at HBV by HCC. More than eight out of ten vaccination of infants began in 1990, (84%) of the almost 700,000 deaths when the WHO estimated that only reported by WHO in 2008 occurred 1% of infants received the recom- in low resource countries. Over 80% mended three doses of hepatitis B of HCC occur in sub-Saharan Africa, vaccine. Although 93% of countries southeast Asia and East Asia (including had introduced the hepatitis B vaccine Mongolia)1,5. At least 80% of all HCC into their routine vaccination sched- are associated with chronic viral infec- ules by 2011 the number actually many decades. In the meantime, over tion with the hepatitis B virus (HBV) vaccinated had risen to only 75%8, 400 million individuals with chronic or hepatitis C virus (HCV). HBV which still leaves a full quarter of the hepatitis B remain at risk from the infections alone account for 75% to world’s infants uncovered and they dire complications of this devastating 80% of these cases. HCV is responsible live in areas of the world with chronic infection. Excellent therapies are now for 10% to 20% of cases6. Additional carrier rates for hepatitis B of up to available which significantly reduce risk factors, which may cause HCC or 20% and more. Coverage in the SE the risk of progression to cirrhosis, act as co-factors in producing cirrhosis Asia Region languishes at only 56%8. liver failure and HCC. However, these and HCC, include consumption of Seven percent of countries still have drugs remain generally unavailable foodstuffs contaminated by the fungal not introduced hepatitis B vaccine in major parts of the world where toxin aflatoxin B1 (AFB1), which con- into their routine childhood vaccina- identical drugs are now routinely taminates groundnuts, maize and tree tion schedules and only 52% recom- available for the treatment of HIV nuts in warm, humid environments mended that the initial dose be given infection. This obvious inequity must in sub-Saharan Africa, SE Asia and within the first 24 hours to prevent be addressed and resolved quickly China. Aflatoxin produces a specific perinatal transmission of the hepatitis before additional large numbers of in- DNA mutation in a hotspot region of B virus as per international stan- dividuals die unnecessarily. Programs the p53 cancer suppressor gene and is dards9. Thirty to forty percent of those to prevent aflatoxin contamination of synergistic with HBV in the produc- infected with chronic hepatitis B can foodstuffs have also been demonstrat- tion of HCC. Some studies suggest a be expected to die from liver failure ed to be highly successful, but remain possible synergistic role with HCV as or HCC. The benefits of national difficult to implement broadly due to well. Other risk factors include excess vaccination campaigns have been lack of education and cost. alcohol intake, diabetes/obesity/non- well documented in areas as diverse HEPATITIS C alcoholic steatohepatitis (NASH) and as Taiwan, The Gambia and Amazo- Prevention of hepatitis C infection rare metabolic disorders, including nia, Brazil, where dramatic drops in presents a somewhat more difficult tyrosinemia, hemochromatosis, alpha-1 hepatitis B carrier rates from 10% to problem because there is no effective anti-trypsin deficiency, and several 1.1%, 10% to 0.6%, and 15.3% to vaccine to prevent hepatitis C infec- prophyrias6,7. 3.7%, respectively, with subsequent tion and there is unlikely to be one The above facts are well known. The drops in the occurrence of HCC, have in the foreseeable future. Prevention two primary causes, HBV and HCV been demonstrated. must rely on education of patients infection, are both preventable and While the benefits of true universal concerning the risks of acquiring treatable and 1 in 12 of the world’s infant immunization against hepatitis HCV infection from exposure to population is currently living with B are obvious as a preventive mea- blood and bodily fluids and strict chronic hepatitis B or C. sure, they will also not be realized for 4 WORLD GASTROENTEROLOGY NEWS APRIL 2013 Editorial | Scientific News | Letter to the Editor | World Congress | WDHD News | WGO & WGOF News | WGO Global Guidelines | Calendar of Events adherence to the principles of infec- tive therapies for hepatitis C are now tragedies whose burden of disease has tion control. The WHO estimated in available which will cure 70% or more been neglected for far too long.
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